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Purpose: To evaluate the clinical outcome of patients with non-small-cell lung cancer treated by targeting low variant allelic frequency (VAF) driver mutations identified through cell-free DNA (cfDNA) next-generation sequencing (NGS). Detection of driver mutations in cancer is critically important in the age of targeted therapy, where both tumor-based as well as cfDNA sequencing methods have been used for therapeutic decision making. We hypothesized that VAF should not be predictive of response and that low VAF alterations detected by cfDNA NGS can respond to targeted therapy., Patients and Methods: A multicenter retrospective case review was performed to identify patients with non-small-cell lung cancer who received targeted molecular therapy on the basis of findings of low VAF alterations in cfDNA NGS. Mutations at low VAF were defined as < 0.2% mutated cfDNA molecules in a background of wild-type cfDNA., Results: One hundred seventy-two patients underwent cfDNA NGS testing. Of the 172 patients, 12 were identified as having low VAF driver alterations and were considered for targeted therapy. The median progression-free survival (PFS) for all patients was 52 weeks (range, 17 to 88 weeks). For patients with EGFR exon 19 deletion (n = 7), the median PFS was 52 weeks (range, 17 to 60.5 weeks). For patients with EML4-ALK fusions (n = 3), the median PFS was 60 weeks (range, 18 to 88 weeks). The median overall survival for all patients after diagnosis was 57.6 weeks., Conclusion: Targeted treatment response for driver mutations detected by cfDNA may be independent of VAF, even in relation to other higher VAF aberrations in plasma, and directly dependent on the underlying disease biology and ability to treat the patient with appropriate targeted therapy.

Background: Integrating palliative care into intensive care units (ICUs) requires involvement of bedside nurses, who report inadequate education in palliative care., Objective: To implement and evaluate a palliative care professional development program for ICU bedside nurses., Methods: From May 2013 to January 2015, palliative care advanced practice nurses and nurse educators in 5 academic medical centers completed a 3-day train-the-trainer program followed by 2 years of mentoring to implement the initiative. The program consisted of 8-hour communication workshops for bedside nurses and structured rounds in ICUs, where nurse leaders coached bedside nurses in identifying and addressing palliative care needs. Primary outcomes were nurses' ratings of their palliative care communication skills in surveys, and nurses' identification of palliative care needs during coaching rounds., Results: Each center held at least 6 workshops, training 428 bedside nurses. Nurses rated their skill level higher after the workshop for 15 tasks (eg, responding to family distress, ensuring families understand information in family meetings, all P < .01 vs preworkshop). Coaching rounds in each ICU took a mean of 3 hours per month. For 82% of 1110 patients discussed in rounds, bedside nurses identified palliative care needs and created plans to address them., Conclusions: Communication skills training workshops increased nurses' ratings of their palliative care communication skills. Coaching rounds supported nurses in identifying and addressing palliative care needs., (©2017 American Association of Critical-Care Nurses.)

Cigarette butts and other postconsumer products from tobacco use are the most common waste elements picked up worldwide each year during environmental cleanups. Under the environmental principle of Extended Producer Responsibility, tobacco product manufacturers may be held responsible for collection, transport, processing and safe disposal of tobacco product waste (TPW). Legislation has been applied to other toxic and hazardous postconsumer waste products such as paints, pesticide containers and unused pharmaceuticals, to reduce, prevent and mitigate their environmental impacts. Additional product stewardship (PS) requirements may be necessary for other stakeholders and beneficiaries of tobacco product sales and use, especially suppliers, retailers and consumers, in order to ensure effective TPW reduction. This report describes how a Model Tobacco Waste Act may be adopted by national and subnational jurisdictions to address the environmental impacts of TPW. Such a law will also reduce tobacco use and its health consequences by raising attention to the environmental hazards of TPW, increasing the price of tobacco products, and reducing the number of tobacco product retailers., Competing Interests: Conflicts of Interest: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

This article is a continuation of the discussion of Copyright Law (found in JNPD 31:5) as it applies to nursing professionals. This part focuses on the definition of "work made for hire" and how nursing professional development specialists can both protect and share their own work. Many nurses assume that they own the works they create, but authorship is not necessarily the same as ownership. Misunderstanding copyrights could put one's job and hard work at risk!

This article covers the basics of Copyright Law as applicable to the use of protected resources and the sharing of information by nurse professionals. It explores frequently cited justifications for copyright violation, including the doctrine of Fair Use and the Technology and Copyright Harmonization Act. It also discusses why those justifications may or may not apply to the nurse professional who teaches in a clinical setting or at a conference.(See CE Video, Supplemental Digital Content 1, http://links.lww.com/JNPD/A2).

Emissions from open detonation (OD), open burning (OB), and static firing (SF) of obsolete military munitions were collected using an aerostat-lofted sampling instrument maneuvered into the plumes with remotely controlled tether winches. PM2.5, PM10, metals, volatile organic compounds (VOCs), energetics, and polyaromatic hydrocarbons (PAHs) were characterized from 121 trials of three different munitions (Composition B (hereafter, "Comp B"), V453, V548), 152 trials of five different propellants (M31A1E1, M26, SPCF, Arc 451, 452A), and 12 trials with static firing of ammonium perchlorate-containing Sparrow rocket motors. Sampling was conducted with operational charge sizes and under open area conditions to determine emission levels representative of actual disposal practices. The successful application of the tethered aerostat and sampling instruments demonstrated the ability to sample for and determine the first ever emission factors for static firing of rocket motors and buried and metal-cased OD, as well as the first measurements of PM2.5 for OB and for surface OD., (Published by Elsevier B.V.)

Objectives: We describe how scientific evidence about obesity has been used in Minnesota legislative materials to understand how research evidence might more effectively be translated into policymaking., Methods: We selected 13 obesity-related bills introduced from 2007 to 2011 in Minnesota. Using state archives, we collected all legislative committee meeting materials and floor testimony related to each bill. We used a coding instrument to systematically analyze the content of a sample of 109 materials for their use of research evidence and non-research-based information., Results: Research evidence was mentioned in 41% of all legislative materials. Evidence was often used to describe the prevalence or consequences of obesity or policy impacts but not to describe health disparities. In 45% of materials that cited evidence, no source of evidence was indicated. By contrast, 92% of materials presented non-research-based information, such as expert beliefs, constituent opinion, political principles, and anecdotes., Conclusions: Despite an abundance of available research evidence on obesity, less than half of legislative materials cited any such evidence in discussions around obesity-related bills under consideration in Minnesota.

Most Americans are not sufficiently physically active, even though regular physical activity improves health and reduces the risk of many chronic diseases. Those living in rural, non-White, and lower-income communities often have insufficient access to places to be active, which can contribute to their lower level of physical activity. The shared use of school recreational facilities can provide safe and affordable places for communities. Studies suggest that challenges to shared use include additional cost, liability protection, communication among constituencies interested in sharing space, and decision-making about scheduling and space allocation. This American Heart Association policy statement has provided recommendations for federal, state, and local decision-makers to support and expand opportunities for physical activity in communities through the shared use of school spaces.

As state and local governments increase restrictions on cigarette smoking, tobacco manufacturers have shifted to marketing alternative tobacco products. Tobacco control laws need to be updated to reflect this shifting marketplace. With the 2010 enactment of the Tobacco Modernization and Compliance Act, Minnesota addressed regulatory gaps and created a model law for other states. We have detailed the updated definitions of tobacco and tobacco products and identified ways that future laws could be strengthened.

This paper highlights methods - other than legislative and regulatory directives - through which decision-makers may use law and the legal system to facilitate the systems-wide change that the IOM calls for., (© 2013 American Society of Law, Medicine & Ethics, Inc.)

Nearly two decades after the birth of American Sexually Violent Predator (SVP) laws and the tolerant review of their legitimacy by American courts, European courts and international bodies are beginning to develop a jurisprudence of their own with regard to preventive detention. Applying international human rights norms, these bodies have been significantly less tolerant of preventive detention, looking not only at their design but also at their implementation. Simultaneously, American courts are showing the beginnings of a second look at SVP laws, inspired and informed not by promises about the future implementation of newly passed SVP laws, but rather by the sorry record of two decades of implementation. This article examines an American SVP scheme as it has been implemented over 20 years, contrasts the international perspective, and offers some speculation about the path of reform for American SVP schemes., (Copyright © 2013 John Wiley & Sons, Ltd.)

Background: Taft-Hartley Health and Welfare Funds ("funds") administer health insurance plans that cover approximately nine million U.S. adults. Unionized workers covered by funds work primarily in blue- and pink-collar occupations and smoke at a rate almost twice that of workers in other occupations. Most funds do not provide comprehensive coverage for tobacco cessation treatment for fund participants (workers, family members, and retirees)., Purpose: This study tested a pilot intervention to increase the provision and promotion of cessation benefits among Minnesota-based funds by educating the funds' advisors., Methods: Tailored educational outreach was conducted to advisors (administrators, consultants, attorneys) of 10 Minnesota-based funds (2009-2011). Pre- and post-intervention advisor interviews measured perceptions/knowledge/attitudes about tobacco use, cessation, coverage, and promotion of benefits. Pre- and post-intervention data on benefit provision were collected from Summary Plan Descriptions (SPDs) and Summary Material Modifications (SMMs) of 10 Minnesota-based funds and 19 comparison funds in Massachusetts and Washington, and compared in 2011. SPDs/SMMs were scored on benefit adequacy, comparing services covered and the extent to which they met DHHS recommendations., Results: Minnesota-based funds provided significantly higher coverage (except for copays and pre-conditions) pre-intervention. However, there were no significant differences between Minnesota and comparison funds in rate of improvement in benefits over time. At follow-up, advisors reported a significant increase in confidence in their knowledge to address smoking issues in funds. Advisors also reported sharing intervention information with fund trustees., Conclusions: Educational strategies to influence advisors who provide guidance to fund trustees may help to increase advisors' confidence to address cessation benefit improvement., (Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Context: Under a grant funded by ClearWay Minnesota(SM) and in partnership with nationally recognized experts in tobacco product regulation, the Public Health Law Center investigated how laws at every level apply, or fail to apply, to noncigarette tobacco products--also called "other tobacco products.", Evidence Acquisition: During the years 2010-2011, standard legal research techniques were used to identify and compile relevant statutes, regulations, decisions, pleadings, proposals, and related materials. Sources included standard commercial legal databases such as LexisNexis and Westlaw, online sources for pending rules and legislation, and direct contact with courts for legal pleadings and unpublished decisions. These legal authorities related to many aspects of the regulation, including price, flavorants, youth access, marketing restrictions, and product design of other tobacco products. Five of these products were used as case studies: dissolvable tobacco products, electronic cigarettes, little cigars, snus, and water pipes., Evidence Synthesis: Research during the years 2010-2011 revealed that the federal regulation of other tobacco products lags behind the regulation of more "traditional" tobacco products, such as cigarettes and moist snuff. Federal regulatory options to expand regulation of these products were identified., Conclusions: The article highlights several federal policy interventions that would address gaps in the regulation of other tobacco products. The FDA must determine whether these interventions will benefit public health and, if so, to what extent--the legal criteria for intervention under the federal Family Smoking Prevention and Tobacco Control Act., (Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Despite the potential for public health strategies to decrease the substantial burden of injuries, injury prevention infrastructure in state health departments is underdeveloped. We sought to describe the legal support for injury prevention activities at state health departments. We searched the Lexis database for state laws providing authority for those activities, and categorized the scope of those laws. Only 10 states have authority that covers the full scope of injury prevention practice; in the others, legal authority is piecemeal, nonspecific, or nonexistent. More comprehensive legal authority could help health departments access data for surveillance, work with partners, address sensitive issues, and garner funding. Efforts should be undertaken to enhance legal support for injury prevention activities across the country.

As communities move toward statewide smoke-free regulation, progress is often stymied by legal and political challenges that arise when multiple cities and counties share regulatory power within what is, for economic purposes, a single population center. Political challenges are exacerbated by legal inconsistencies and uncertainties, such as confusing and conflicting lawmaking power in boards of health, cities or counties, and diverse procedures and timelines for adopting and amending ordinances. Surprisingly little research is available about the legal and political obstacles communities face in regulating tobacco on a regional basis. Researchers used case study methodology to analyze legal and political challenges that seven multi-jurisdictional Minnesota regions faced in smoke-free ordinance campaigns between 2000 and 2006, to examine the approaches regulatory authorities took in each of these communities, and to identify strategies to help public health advocates, health organizations, policymakers, and legal professionals anticipate, avoid, and address these obstacles. Legal impediments included confusing rules for passing smoke-free laws via ballot measures (initiatives and referenda); distracting lawsuits; and conflicts over legal jurisdiction. Political challenges included the recurrent argument for regional consistency, protracted timelines, pending legislation and elections, and mayoral vetoes. Legal and political challenges similar to those in this study appear in smoke-free campaigns across the U.S. By recognizing the risks posed by these obstacles, advocates will be better prepared to advance smoke-free policies effectively.

State and local alcohol policies can minimize opportunities for people to use alcohol, thereby reducing consumption and alcohol-related problems. Little is known, however, about the prevalence of campus policies aimed at reducing college students' alcohol use and related problems. The authors surveyed school administrators in Minnesota and Wisconsin to assess the frequency of alcohol policies and whether institutional characteristics were likely to predict campus policies. They also compared administrators' responses to policies posted on college Web sites. Most schools prohibited beer kegs and provided alcohol-free housing for students. A minority of schools prohibited all alcohol use on campus or at Greek organizations or banned advertisements in school newspapers for alcohol or off-campus bars. The prevalence of policies varied with school characteristics, and agreement was poor between Web-site policy information and that provided by administrators. Further research on the prevalence of college alcohol policies might be useful for assessing trends and future prevention needs on campuses.

Sex offender registration and community notification laws, now in effect nationwide, have inspired considerable controversy. This article examines the variety of legal challenges brought against the laws since the mid-1990s and surveys issues likely to receive judicial attention in the immediate future. The article also provides an overview of the limited empirical work done to date on registration and notification, and the major areas that warrant additional research, including, most notably, inquiry into efficacy, costs, and consequences.

In the past three decades, the legislative response to sexual violence has undergone two sets of reforms. The feminist reforms, beginning in the 1970s, sought to modify legal forms and practices to reflect new theories of the nature of sexual violence. The "regulatory" reforms of the 1990s were atheoretical, and adopted a "preventive" strategy to close perceived gaps in the system of social control. This article examines the second wave of reform, with special emphasis on Sexually Violent Predator (SVP) laws. It summarizes the current legal controversies generated by these laws, and suggests that the underlying assumptions and forms adopted by the 1990s reforms may undercut some of the advances achieved by the feminist reforms in understanding and addressing sexual violence.

Sex offender commitment laws use a mental health commitment model to lock up the "most dangerous" sex offenders after their prison sentences expire. In Kansas v. Hendricks, the United States Supreme Court rejected the major constitutional challenges to these laws. The Hendricks case clarifies important ambiguities about the use of civil commitment to enforce "police power" interests, as opposed to "parens patriae" interests. Hendricks also clarifies the role of "treatment" in justifying civil commitment. While there remain some important legal issues to be resolved, the future direction of sex offender commitment schemes will turn most significantly on policy decisions. The behavioral sciences can play an important role in shaping these decisions. The most significant questions concern whether expensive commitment programs are the most effective use of scarce treatment and supervision dollars. Additional research should be directed to improving dynamic predictors of recidivism, operationalizing "inability to control" standards, judging the "social meaning" of commitment laws, and assessing the potential treatment disincentives of these laws., (Copyright 2000 John Wiley & Sons, Ltd.)

Civil commitment laws intended to prevent sexual violence are being considered and enacted by many state legislatures. In their use of "preventive detention" to lock up the "most dangerous," the laws are highly controversial legally and morally. As well, critics raise questions about the extent to which the laws advance their stated goals. Considering the growing expense of these programs, evaluation efforts based on an empirical foundation are imperative. This study collected data on all 116 men committed under Minnesota's program during the period 1975-1996. The authors report descriptive summary data on admission rates and population trends, demographic characteristics of detainees and victims, pre-commitment criminal and mental health histories, and current status of detainees. The article also compares the committed group with sex offenders in the state's correctional system. The article describes the history and functioning of sex offender commitment programs, and draws implications for policy-makers from the data presented., (Copyright 2000 John Wiley & Sons, Ltd.)